Ventilation tubes and persisting tympanic membrane perforations

Otolaryngology Head and Neck Surgery August 1997

P158 ScientificSessions-- Wednesday

plied to all children undergoing adenotonsillectomy for determination of need for admission, regardless of age and diagnosis. Methods: We retrospectively reviewed 210 pediatric patients (<12 years old) undergoing tonsillectomy or adenotonsillectomy, managed with a low threshold for admission, and a prospectively analyzed 100 patients scheduled as outpatients during the years 1994 to 1997. Records were characterized by type of procedure, age of patient, primary diagnosis, other medical diagnoses/problems, admission status, and complications or postoperative problems. Results: If patients had a normal respiratory pattern with normal Sat2, no bleeding, and adequate oral intake at 4 to 6 hours after adenotonsillectomy, they were typically discharged. This included many children less than 4 years of age and many with the diagnosis of obstructive sleep apnea. Conversely, all patients with significant respiratory problems were identified within a 1-hour to 4-hour period after surgery. Conclusions: Serious postoperative respiratory complications appear to be manifested within the first several hours after adenotonsillectomy. Patients carefully screened for discharge criteria can be managed as outpatients, regardless of age or diagnosis. 11:16 AM

Ventilation Tubes and Persisting Tympanic Membrane Perforations AVISHAY GOLZ, MD (presenter), AVIRAM NETZER, MD, S. THOMAS WESTERMAN, MD, LIANE M GILBERT, MA, and H. Z. JOACHIMS, MD, Haifa, Israel, and Shrewsbury, N.J.

Objective: Myringotomy and insertion of ventilation tubes (VT) as a form of treatment for recurrent acute otitis media (AOM) and persistent middle ear effusion (MEE) is the most common otologic operation performed on children. Even though it is a relatively simple procedure with considerable benefits, unfortunately it has some complications, one of which is a persisting perforation of the tympanic membrane (TM) occurring after the extrusion or the removal of the tubes. This study was designed to examine the extent of this complication and to identify characteristics of patients with persisting perforations of the TM related to VT insertion. Methods: One thousand three hundred sixty children (2604 ears) who underwent VT placement during the years 1980 to 1994 were studied according to the following criteria: sex, age when tubes were inserted, indication for tube placement (AOM or MEE), type of tube used, number of previous tube insertions, postoperative complications (infections and otorrhea), duration of intubation, and whether the tubes were extruded spontaneously or removed. Time of followup after extrusion of the tubes was from l to 15 years. Results: Persisting perforations were seen in 2.8% of all the operated ears (73 ears). The incidence of a persisting perforation was higher in the younger age group (less than 3 years old), when the indication for tube placement was recurrent AOM, with the use of Goode tubes (compared with home-made polyethylene tubes), in cases of multiple tube insertions, when the intubation period was longer than 18

months, and when there were three or more episodes of otorrhea while the tubes were in place. No correlation was found with the sex of the children or with whether the tubes were removed or extruded spontaneously. Conclusions: In light of the large number of ears studied, the many criteria used, and the prolonged follow-up period, this study provides important data regarding the risk of a persisting TM perforation following VT insertion. 11:30 AM Hearing Results in Pediatric Patients After Ossicular Reconstruction TERRENCE P. MURPHY, MD, FACS (presenter), Atlanta, Ga.

Objective: To examine hearing results in pediatric patients after ossicular reconstruction with various techniques. Methods: A retrospective chart review was performed for 72 pediatric patients who underwent ossicular reconstruction from 1991 to 1996. Patient's audiograms were evaluated preoperatively and postoperatively for pure tone averages (PTA), air-bone gap, speech reception threshold, method of ossicular reconstruction, and management of the mastoid. Results: Thirty patients underwent ossicular reconstruction with TORPs. Twenty patients had an average improvement of the PTA by 20 dB with an average postoperative air-bone gap of 25 dB, eight patients had no change in hearing, and two patients had a decrease in the PTA by greater than 10 dB postoperatively. Twenty-nine patients underwent ossicular reconstruction with PORPs. Fourteen patients had an average improvement of the PTA by 20 dB with an average postoperative air-bone gap of 14 dB. Twelve patients had no change in hearing postoperatively, and three patients had a decrease in the PTA postoperatively by greater than 10 dB postoperatively. Thirteen patients underwent ossicular reconstruction with a cartilage block to the stapes superstructure. Eight patients had an average improvement of the PTA by 10 dB, two patients had no change in hearing, while three patients experienced a decrease in postoperative PTA by an average of 22 dB. Conclusions: Excellent hearing was obtained in 66% of pediatric patients who had ossicular reconstruction with TORPs and 50% of pediatric patients who underwent ossicular reconstruction with PORPs. Hearing results with TORPs and PORPs were superior to that obtained with cartilage to stapes reconstruction. 11:38 AM Cerebrospinal Fluid Leak Repair with Hydroxyapatite Cement PETER D. COSTANTINO, MD (presenter), CRAIG D. FRIEDMAN, MD, ALEX GNOY, MD, JOHN F. KVETON, MD, CARL SNYDERMAN, MD, PETERJ. CATALANO, MD, and GUY J. PETRUZZELLI, MD, New York City, N.Y., Philadelphia and Piltsburgh, Pa., New Haven, Conn., and Maywood, III.

Objective: Despite recent advances in neurosurgery and reconstructive surgery, cerebrospinal fluid leaks continue